We've seen a slight reduction in the past week of the daily rate of new infections - possibly good news, though our low levels of testing make it too early to make a clear call on where we are. While lower, our daily new infection rate remains among the highest in the world.

After running in the 100-115k range the week of March 30th, and 150k the week of April 6th, the US testing rate this past week came in at 148k a day, a slight dip and is staying there this week - not good peeps. According to the Wordometers tracker, the US is high 30s/low 40s in the world in total tests per capita - a remarkably low figure given how widely the virus has spread here. As of Sunday, 32 countries had done 50% more testing than the US, and 19 TWICE as much. One would have imagined that a country this deep into its deadly outbreak would have dramatically accelerated its testing regime - and while it has improved, it has not kept pace with what is needed or is commonplace in other nations.

The US's continued struggle with testing of course raises questions about our ability to stand the country back up, a process which will require us to be testing at far higher rates (3-5-10 times?) with tests which provide immediate results - not the many day wait which is the standard now. Politico has a new story about our ongoing testing fiasco, as does last Friday's Washington Post.

As this Newsweek article reminds us VP Mike Pence promised 5m tests by March 13th, and others in the Administration said there would be tens of millions of tests available soon after. More than a month later we've only tested 4m people, and won't hit Pence's promised 5m number until the end of this month - six weeks after those tests were supposedly in place, ready to go. We still need to know what happened to all those tests the VP promised us.

America Needs A Plan to Defeat COVID19, Not More Magical Thinking - It's been more than three months now since the first recorded COVID death in the US, and it is hard to put into words has little the US government has done to tackle the public health side of this crisis. The President’s main initiative, his travel bans, clearly didn’t work; our testing/tracing regime still isn’t fully up and running; the President's unwillingness to provide equipment to hospitals remains reckless, inexplicable and sadistic; social distancing and school/business closures have all been done at the state and local level - a process he has repeatedly undermined.

Recently the President said that he doesn't believe that fighting COVID19 is a federal responsibility despite his "wartime" language. He ignored repeated warnings from his own intelligence community that COVID could be the big one. His refusal to craft a single national strategy to mitigate the spread of the virus will end up costing us many many lives and untold damage to our economy and society more broadly; that the President is relentlessly lying and misninforming all of us about what is happening makes it all that much more worse.

We agree with with the assessment of Jeremy Konyndyk in this new thorough Guardian look at what went wrong here in the US: "We are witnessing in the United States one of the greatest failures of basic governance and basic leadership in modern times.” The Washington Post and the New York Times have also both published sweeping examinations of all Trump's early mistakes and those the days squandered.

The exploding infection rate here in the US proves the President's approach hasn't worked. In recent weeks expert opinion has settled around a plan similar to the one we've been advocating:

1. Surge medical equipment/beds/staff to the front lines

2. Stand up a testing/isolation regime like South Korea's

3. Implement a mandatory national 21 day stay at home program (not just recommendations)

4. Launch a Manhattan Project for a vaccine/testing/etc (this is our #4, not all agree)

The economy cannot stand back up until the virus is tamed, and it's time for the President's magical thinking to end. Now that Congress has taken dramatic steps to aid the US economy, it must step in now and make sure America finally has a plan to defeat the virus. Our hope is that Speaker Pelosi form some kind of alliance with the nation's governors to not just get this plan in place but oversee its implementation in the coming months. Getting America stood back up depends on it. Such an alliance will also make it far harder for the President to keep pitting state against state, region against region.

New from NBC News - "The Trump administration's decision to let states chart their own responses to the coronavirus crisis rather than impose a national strategy will cost thousands of lives and is likely to result in an open-ended outbreak rolling across the country, a dozen public health experts told NBC News.

The only way to win what President Donald Trump has called a war against an "invisible enemy" is to establish a unified federal command, the experts insist — something Trump has yet to do. So far, the federal government hasn't leveraged all its authority and influence to dramatically expand testing and tracing measures, ensure a sufficient supply of crucial medical equipment or require residents of all 50 states to stay at home."

In a recent Today show interview Dr. Brix acknowledged the national social distancing effort has been inadequate, the national testing regime is still not yet stood up and if everything goes right the death toll in the US will be 100-200k. Senator Chris Murphy echoed this dispair at the lack of an effective national response in a new interview with Greg Sargent, and as did Rep. Adam Schiff in this interview. For more on what we need to do right now see these excellent essays:

NDN's been asking our readers and members to call Congress every day until the President puts a plan in place and is clearly producing real results. As we say above, the plan should include 3 core elements:

Surge Equipment/Beds/Staff To the Frontlines – The President and Congress have to take responsibility for a national plan to handle the extraordinary health care crisis that the nation will face in just a few days’ time. We need wartime-level production of protective gear, ventilators, ICU beds, and isolation/quarantine wards. We will need a way to employ more health care workers too – perhaps with temporary unemployment rising there can be a way to take qualified people and crash train them as hospital/health care staff.

The President’s refusal to take responsibility for this part of our national response remains hard to understand and explain. Congress must step in here and force both a funded national strategy and compliance with it in the coming days. If the President really wants to show his support for a robust US healthcare system, the President should withdraw his support for a lawsuit which could cripple the ACA in the midst of this pandemic and encourage every state to expand Medicaid so more of our citizens get the care they need. The President should also reverse hiis cruel new decision to prevent states from opening the ACA enrollment period to help ensure Americans who want to find health insurance right now can find it.

Congress should open up an immediate investigation into news reports that Trump has sent life saving equipment to favored states and held it from ones he didn't like. The Governors of CO, CT,KY,MA, MI and MT have all complained that supply orders they'd made were taken by the federal government - why is this still happening and where are all the seized supplies going?

See these compelling clips of MD Gov Larry Hogan and NY Gov Andrew Cuomo discussing the dire supply chain issues facing the country. Reports that US companies were still selling this critical equipment to overseas buyers are disturbing, as are the wildly ignorant statements by Jared Kushner from the White House podium recently about how the national supply chain was supposed to work.

Would the states be on their own if a foreign nation attacked the US? In a terrorist attack? A natural disaster, extreme weather event? A serial killer who crosses state lines? If immigrants surged to our border, or if cartels were flooding the states with drugs? Or a recession, like now - didn't we see a strong coordinated federal response? Why would a pandemic, which has planned for over many years, and which the US was prepared for - be any different? The idea that the states are on their own to battle something which is affecting everyone American no matter where they live is among the most outrageously stupid moments in this terrible affair.

In a related matter, it looks like the Senate GOP's war profiteering scandal - an extraordinary betrayal of the public trust - just got a whole lot worse.

On the good news front it appears the Army Corp of Engineers is being deployed to help build more medical facilities in US hot spots. There are many reports now of this process being well underway and successful.

More, Better, Faster Tests – While things have gotten better on the testing front, we still have a very long way to go before our tests are ubiquitous and rapid – everywhere and done in minutes/hours, not days. If we are ever to return to normal, efforts to aggressively screen and isolate those with infection (in public buildings, ports of entry, schools, and sports arenas) will have to become routine – like texting a friend. This Guardian story looks at how mass testing helped slow the virus's spread in one Italian town, and this new article in Science magazine explains how mass testing was key to South Korea's flattening of the curve without major lock downs. This new Atlantic article by Alexis Madrigal and Robinson Meyer is an excellent deep dive on the importance of testing, and our massive failure to get it right so far.

Developing ways of proving that you’ve had the virus and are now immune will also be really important, and would require, obviously, that every single American be tested at some point. We found this thread by Yale Professor Nicholas Christakis to be helpful in understanding the issues around immunity and the need for rapid, ubiqitous "serology" tests which are of a different kind than the "PCR" tests which are being deployed right now. The Washington Post just published this smart look at the importance of sreology tests for standing the country back up.

So, yes, we are talking about billions, not tens of thousands, of tests. The government should be making this kind of ubiquitous rapid testing regime part of the mandate of a new “Manhattan Project” which works to not just defeat COVID but give America far better tools to fight future pandemics. For more on the need for crashing a broad regime for advance a vaccine, therapeutics, hospital equipment and diagnostics see this thread from Dr. Scott Gottlieb and this Boston Globe op-ed from Senator Markey and Peter Slavin.

We've started receiving good news on the testing front:

- the FDA recently announced the approval of a rapid point of care PCR COVID19 test by the California company, Cepheid. This test will be particularly important in hospitals and other triage facilities, and in keeping our front line health care professionals from getting sick themselves.

- Abbott announced FDA approval for a 5-13 minute desktop PRC test - a huge advance if it can realized in the coming weeks.

Implement National Stay at Home/Develop A National Strategy For Students and Kids – As part of eventually developing a true national "stay at home" social/physical distancing strategy the US govt will have to help communities and families come to terms with what it means that kids may be home until the fall semester (no schools, summer activities). This is a large and important area which needs far more attention and creativity, but two initial thoughts:

1) Their Health – the early messages about young people being less vulnerable to COVID-19 and thus somehow less responsible has to be corrected aggressively in the days ahead. We know from data that young people in other countries have become infected at very high rates, and seem to be critical to the rapid transmission of COVID. But it is also for themselves – early data here in the US show that young people are turning up in ICU units at much higher rates than in China, and COVID can permanently damage the lungs of anyone infected.

Gov Cuomo weighed in last Saturday on the need to change our collective mindset about young people, Tweeting "Younger people listen up: 55% of NYS #Coronavirus cases are ages 18-49. Young people aren’t invincible. You can get this and you can give it to someone older you love. You shouldn’t endanger your own health & you certainly shouldn't endanger other people's health. #StayAtHome." More leadership like this please.

2) Their Sanity - What do we do with our kids for the next six months if schools and summer camps are cancelled? This is not just a sanity thing for these students and families - having kids at home will make it far harder to stand the economy back up when the virus ebbs.

It is our recommendation that all schools and colleges involved in distance learning now develop a “pandemic module” to help young people better understand how to stay safe, reduce infection, and navigate the rigors of life at home, away from their friends and the lives they’ve built for themselves. These kinds of courses may be the most valuable things that schools can do in the months ahead.